Healthcare Provider Details

I. General information

NPI: 1447468830
Provider Name (Legal Business Name): SURGEONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 E 146TH ST STE 100
NOBLESVILLE IN
46060-3097
US

IV. Provider business mailing address

9660 E 146TH ST STE 100
NOBLESVILLE IN
46060-3097
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-6677
  • Fax: 317-773-3322
Mailing address:
  • Phone: 317-773-6677
  • Fax: 317-773-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50000148A
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT FRANKLIN JACKSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 317-773-6677